I learned a few things that day. One was that we as medical professional groups stick to our kind and read our own research. (Mostly) We also see these medical problems through our own professional lens. I tend to look at the cervical spine and a musculoskeletal answer for a patient’s pain. A neurologist looks at their toolbox and finds a drug that will work. A proctologist… well, you get the gist. Here are a few questions we can ask ourselves to get better at the practice of medicine.
What is the lens that you are using to look and assess the problems of the patient before you?
Who can you build a relationship with to ‘broaden your view’ of the problems of our patients?
Another thing I learned was that there was a connection that explained why addressing upper cervical structures could have a powerful effect on migraines.
“This pattern of innervation could, for example, explain the aggravating influences of neck muscle tension on tension‐type headache and migraine.”
The conclusion at the end of the round table was that these neurologists needed “better drugs”. The discussion at the end of the article suggested that this interconnection could explain why manual therapies, as well as Botox and injections, work in reducing or resolving tension type headaches and migraines. This was not the ‘take home’ from the panel but a medication option.
“and may explain why manual therapies of pericranial structures can be successful in the management of headaches. It may also partly be an explanation for the beneficial effects of local anesthetic or botulinum toxin injections into peripheral nerves, or the so‐called trigger points of pericranial tissues.”
When Botox or injections work we need to ask the question ‘why’. Why did these injections help? Why are the upper cervical muscles under load or tension?
A recent case that I had the privilege of working with had an MRI ordered of the cervical spine. Her pain was consistently at the C2 level, and the articulations above and below. She had no nerve findings of weakness or sensory changes. The radiology report did not include any description above the body of C2 and the focus was on the mid cervical spine. This area was not clinically painful to any testing. There was a finding that was relevant and signal changes were different form one side to the other. Can you spot the difference? Let Sesame Street help you. “One of these things is not like the other.” (Hint: check out the area of the alar ligaments.)